WO2004008996A1

WO2004008996A1 - Percutaneous endovascular apparatus for repair of aneurysms and arterial blockages

Info

Publication number: WO2004008996A1
Application number: PCT/US2003/022726
Authority: WO
Inventors: Timur Paul Sarac
Original assignee: Timur Paul Sarac
Priority date: 2002-07-22
Filing date: 2003-07-22
Publication date: 2004-01-29
Also published as: US20040122510A1; ES2632999T3; EP1534182A1; EP1534182B8; US7101393B2; WO2004008996A9; AU2003256633A1; EP1534182B1

Abstract

An endovascular apparatus is provided for treating the effects of vascular disease including aneurysms and arterial blockages using a percutaneous, minimally invasive technique. In one embodiment the endovascular apparatus includes a tubular sleeve (12) having a cranial end (14), a first caudal branch (16), and a second caudal branch (18) such that the tubular sleeve is shaped like an upside down 'Y.' The apparatus further includes at least one expandable attachment device (20) attached to the tubular sleeve for securing the endovascular apparatus to an interior wall of a vessel. The at least one expandable attachment device includes a plurality of telescoping segments (40) similar to the telescoping segments of a presentation pointer. Accordingly, during percutaneous insertion of the endovascular apparatus into a patient the attachment device can be collapsed into a small profile. Once positioned at the site of the aneurysm the telescoping attachment device can be expanded to hold the endovascular apparatus in place adjacent the inner lumen wall.

Description

PERCUTANEOUS ENDOVASCULAR APPARATUS FOR REPAIR OF ANEURYSMS AND ARTERIAL BLOCKAGES

TECHNICAL FIELD

The present invention relates generally to an endovascular apparatus for the treatment of aneurysms or arterial blockages, and more particularly, to an endovascular apparatus having an expandable attachment device for securing the endovascular apparatus to an interior wall of a lumen.

BACKGROUND

An abdominal aortic aneurysm is an abnormal enlargement or "ballooning out" of the arterial wall of the aorta in a region that passes through the abdominal cavity, usually below the renal arteries and above the common iliac arteries. The aneurysm may also extend into the common iliac arteries. Such aneurysms are typically brought on by the weakenmg of the arterial wall from vascular disease. Although abdominal aortic aneurysms often do not cause pain, unless treated, an aneurysm may rupture causing a fatal hemorrhage in a patient.

In the past aortic aneurysms were treated almost exclusively by surgical repair. Specifically, the aneurysm would be resected and replaced by an artificial artery known as a prosthetic graft. Because of the substantial risks associated with such an invasive surgery, however, other treatments for aortic aneurysms have been proposed including endovascular grafting.

Endovascular grafting involves the placement of a prosthetic graft within the lumen of the artery such that the graft spans the length of the aneurysm. In this manner the aneurysm can be excluded from the circulatory system rather than resected. Using a catheter as a deployment device, the endovascular graft can be introduced into the vascular system percutaneously. Once the graft has been positioned at the site of the aneurysm it can be attached to the vascular wall both above and below the aneurysm using expandable attachment devices to prevent movement of the graft after deployment.

To introduce an endovascular graft percutaneously, the graft must be collapsible into ' a small profile for negotiating the vascular system. Upon reaching the site of the aneurysm the graft and its attachment devices can be expanded into a desired shape using an inflating balloon catheter or other actuator. A variety of expandable attachment devices have been proposed for securing an endovascular graft to an interior wall of a vessel most of which use stents with hooks or barbs to penetrate the intima of the vessel. None of the proposed attachment devices, however, have been found to be ideally suited for use with an endovascular graft.

Accordingly an endovascular apparatus having a new expandable attachment device is desired. The new attachment device ideally should be small with a low profile and should expand to many times its initial diameter. It also should exert enough radial force when expanded to fix into the aorta and thereby reduce blood leaks around the apparatus.

SUMMARY

In a first aspect, an expandable attachment device for securing an endovascular apparatus to an interior wall of a lumen is provided. The expandable attachment device may include a plurality of telescoping arms that are joined together to form an expandable ring. This ring may function similarly to stents. The expandable attachment device may be attached to an endovascular apparatus for the treatment of aneurysms or blockages, such as a graft or stent, or to a heart valve and may include barbs, hooks, or other fasteners about its perimeter for attaching to the interior wall of a lumen. Because the attachment device can be collapsed to a size that can be fed through a vessel, the attachment device and an associated endovascular apparatus can be deployed percutaneously in a patient. Once positioned at the site of an aneurysm or arterial blockage, the telescoping attachment device can be expanded to hold the endovascular apparatus in place adjacent the inner lumen wall.

In a second aspect, an endovascular apparatus is provided for treating aneurysms or arterial blockages using a minimally invasive technique. The apparatus includes a tubular sleeve having a cranial end and at least one caudal branch. If the tubular sleeve includes a first caudal branch and a second caudal branch then the tubular sleeve is shaped like an upside down "Y." Accordingly, for the treatment of abdominal aortic aneurysms the cranial end may be positioned in the infrarenal aorta, the first caudal branch may be positioned in one of the common iliac arteries, and the second caudal branch may be positioned in the other common iliac artery. The tubular sleeve may be made from materials conventionally used to make endovascular grafts including synthetic fabrics or films, DACRON™, or expanded polytetrafluoroethylene (ePTFE) so as to define a lumen and so as to be collapsible during percutaneous insertion into a patient's vascular system.

The endovascular apparatus further includes an expandable attachment device attached to the cranial end of the tubular sleeve for securing the apparatus to an interior wall of a vessel above an aneurysm. The expandable attachment device comprises a plurality of telescoping arms that are attached to form an expandable ring. Each telescoping arm is similar to an expandable presentation pointer. Alternatively, each telescoping arm may function like an accordion. Accordingly, during percutaneous insertion of the endovascular apparatus into a patient, the attachment device can be collapsed into a small profile. Once the apparatus is positioned at the site of the aneurysm or blockage, the expandable attachment device can be expanded to hold the endovascular apparatus in place adjacent the inner lumen wall. Fixation components may be positioned around the perimeter of the attachment device and may be partially embedded in the inner wall of the vessel to secure the attachment device.

The plurality of telescoping arms may be made from materials suitable for use in the human body including stainless steel, plastic, or an alloy of nickel and titanium generally known as NITINOL ™. NITINOL is commonly used in the manufacture of medical devices that are to be deployed in a compressed state through a catheter because of its unique thermal memory properties. For example, a NITINOL part may be manufactured in a first condition and then cooled and compressed into a second condition. When heated to the body temperature of the patient the NITINOL part will expand to its original first condition.

In another aspect one or more expandable attachment devices may be attached to the one or more caudal branches of the tubular sleeve for securing the one or more caudal branches to the interior of the vessel wall.

BRIEF DESCRIPTION OF THE DRAWINGS

Figure 1 is a schematic illustration of an endovascular apparatus according to a first aspect;

Figures 2A-D show the endovascular apparatus of Figure 1 in various states or expansion; Figure 3 is a schematic illustration of an endovascular apparatus according to a second aspect;

Figure 4A is a top view of an expandable attachment device according to a first aspect in a fully collapsed state;

Figure 4B is a top view of the expandable attachment device of Figure 4A in a partially expanded state;

Figure 4C is a top view of the expandable attachment device of Figure 4A in a fully expanded stated;

Figure 5 is a locking mechanism according to a first aspect in a first position;

Figure 6 is the locking mechanism of Figure 5 in a second position;

Figure 7 is a cross section of a segment of a telescoping arm according to a first aspect;

Figure 8 is an endovascular apparatus according to a third aspect;

Figure 9 is an endovascular apparatus according to a fourth aspect;

Figure 10 is an illustration of a typical abdominal aortic aneurysm located in the infrarenal aorta;

Figure 11 is a catheter for percutaneous introduction of an endovascular apparatus into a body lumen;

Figure 12A is a schematic top view of an expandable attachment device according to a second aspect in a partially expanded state;

Figure 12B is a schematic top view of the expandable attachment device of Figure 12A in a fully expanded stated;

Figure 12C is a schematic side view of the expandable attachment device of Figure 12A; Figure 12D is a schematic side view of the expandable attachment device of Figure 12B;

Figures 13A-G are schematic top views of an expandable attachment device according to a third aspect in various states of expansion;

Figures 13H-N are schematic side views of the expandable attachment device of Figures 13A-G;

Figures 13O-U are schematic isometric views of the expandable attachment device of Figures 13A-G;

Figure 14 is a schematic illustration of the endovascular apparatus of Figure 1 having telescoping support columns;

Figure 15 is a schematic illustration of an endovascular apparatus according to another aspect;

Figure 16 is a schematic illustration of an expandable attachment device according to another aspect; and

Figure 17 is a schematic illustration of a telescoping catheter for percutaneous introduction of an endovascular apparatus into a body lumen.

DETAILED DESCRIPTION

An endovascular apparatus 10 according to a first aspect is shown in Fig. 1. The endovascular apparatus 10 includes a tubular sleeve 12 having a cranial end 14, a first caudal branch 16, and a second caudal branch 18. In other embodiments, termed "uni-iliac" devices, the tubular sleeve 12 may include only a single caudal branch. The tubular sleeve may be made from DACRON, ePTFE, peritoneum, fascia, or other common graft material so as to form a flow path for by-passing an aneurysm.

The endovascular apparatus 10 further includes a first expandable attachment device 20 attached to the cranial end 14 of the tubular sleeve 12, a second expandable attachment device 22 attached to the first caudal branch 16 of the tubular sleeve 12, and a third expandable attachment device 24 attached to the second caudal branch 18 of the tubular sleeve 12. The expandable attachment devices 20, 22, 24 may include holes 26 which may be sewn or sutured to the tubular sleeve 12. Alternatively, in lieu of holes 26, the expandable attachment devices can be woven into the sleeve.

In another embodiment, the endovascular apparatus 10 may include a fourth expandable attachment device 28 that is attached to the first expandable attachment device 20 by support columns 30. The fourth expandable attachment device 28 may be positioned above a patient's renal arteries, superior mesenteric artery or celiac artery. The support columns 30, which may be made from NITINOL or stainless steel, may provide columnar support and strength for the endovascular apparatus 10 while permitting blood flow to arteries located between the first expandable attachment device 20 and the fourth expandable attachment device 28.

The support columns 30 may be either wires or tubes. If tubular, the support columns 30 may also be telescoping. For example, in another embodiment depicted in Fig. 14, the support columns 31 may comprise a plurality of incrementally sized segments that are slideably engaged and fit within one another. Thus, in this embodiment the endovascular apparatus 10 may be inserted percutaneously into a vessel with the support columns 31 contracted such that the axial distance between the first expandable attachment device 20 and the fourth expandable attachment device 28 is reduced. During deployment of the endovascular apparatus 10 the support columns 31 may be expanded, thereby permitting the first expandable attachment device 20 to be positioned below the renal arteries while the fourth expandable attachment device is positioned above the renal arteries. In yet another embodiment, shown in Fig. 14, the tubular support columns 30, 31, whether telescoping or not telescoping, may contain an adhesive and include ports or apertures 33 such that the adhesive can escape the support columns 30, 1 upon deployment to assist in securing the endovascular apparatus 10 to the wall of a vessel.

As illustrated in Figs. 2A-2D, the endovascular apparatus 10 is collapsible for easy insertion and navigation through a patient's vascular system using a catheter. Particularly, as illustrated in Fig. 2A, the attachment devices 20, 22, 24, and 28 may be radially collapsed into a profile that is small enough to fit in a catheter sheath. When the attachment devices 20, 22, 24, 28 are deployed from the sheath at body temperature, the devices may be expanded by a balloon or other actuator to a size and shape in which they are able to retain the sleeve 12 against the wall of a vessel.

The endovascular apparatus 10 according to a second aspect is shown Fig. 3 in which the tubular sleeve 12 is supported by support columns 32. The support columns 32 may attach the first expandable attachment device 20 to a fifth expandable attachment device 34. Likewise, the support columns 32 may attach the second and third expandable attachment devices 22, 24 to the fifth expandable attachment device 34 which may be located at the juncture of the first caudal branch 16 and the second caudal branch 18 of the tubular sleeve 12. In addition the support columns 32 may be sewn or sutured to the exterior of the tubular sleeve 12. This may provide continued columnar support throughout the endovascular apparatus 10 to prevent migration within the vessel. The support columns 32 may be telescoping as described with respect to Fig. 14.

Referring to Fig. 4A, an expandable attachment device 20 according to a first aspect is shown in a fully collapsed state. The attachment device 20 includes a plurality of fixation components 36 positioned about the perimeter of the device 20. A port 38 is located at the center of the attachment device 20. The port 38 is sized so as to receive a balloon or other actuator during deployment. The balloon may be inflated to expand the attachment device 20 after insertion into a vessel. Fig. 4B shows the attachment device 20 in a partially expanded state. Fig. 4C shows the attachment device 20 in a fully expanded state.

Referring to Fig. 4C, a telescoping arm 40 is used to attach each fixation component 36 to an adjacent fixation component 36. The telescoping arm 40 may be pivotably attached to a fixation component 36 at one or both ends of the arm 40. A telescoping arm 40 is made up of a plurality of segments 42. The segments 42 may be in slideable contact with one another and may be incrementally sized so as to fit within one another. For example, each telescoping arm 40 may be constructed from what is referred to generally as "nested tubes." When the telescoping arms 40 are fully extended the attachment device 20 may resemble a polygon having fixation components 36 located at its vertices. The fixation components 36 may include barbs or prongs 67 (shown in Fig. 8) for fixation to a vessel wall. In another embodiment shown in Fig. 16, the telescoping arms 40 may contain an adhesive and include ports or apertures 41 such that the adhesive can escape the telescoping arms upon deployment to assist in securing the endovascular apparatus 10 to the wall of a vessel. As one of ordinary skill might appreciate, the attachment device may take variety of shapes depending upon the configuration of the telescoping arms 40 and the fixation components 36. For example, referring to Figs. 12A-D, the telescoping arms 40 may be positioned in a single plane. Alternatively, referring to Figs. 13A-U, the telescoping arms 40 may be positioned in multiple planes in, for example, what is referred to herein as an "M configuration." One possible advantage of the M configuration is that it may produce superior radial force for holding the attachment device in position. In addition, the M configuration may produce the same ratio of expansion (i.e., the ratio of the final outer diameter of the attachment device in its expanded state to the initial outer diameter of the attachment device in its collapsed state) as the "single plane configuration" using fewer parts.

To keep the telescoping arms 40 in their final extended state after deployment in a vessel, a one-way latch may be used to lock adjacent segments 42. Fig. 5 shows one possible latch 44, in a first position, for locking the telescoping arms 40. The latch 44 may consist of a one or more grooves 46 associated with a first segment 48 and a tooth 50 associated with a second, adjacent segment 52. As the telescoping arm 40 is expanded, the second segment 52 moves in a first direction A relative to the first segment 48. The tooth 50 and the grooves 46 are aligned so as to engage when the telescoping arm 40 is extended. Once the tooth 50 engages a groove 46, as shown in Fig. 6, the second segment 52 may not move in a second direction B relative to the first segment 48. Accordingly, the telescoping arm 40 is free to extend but may not collapse once extended. Of course other one-way latches may be used to lock the segments 42 of the telescoping arms 40. Fig. 7 illustrates one possible cross-section of a segment 42 of the telescoping arm 40. This "rail" design permits room for sliding and positioning of a one-way latch, like the one shown in Fig. 5, between segments 42 shown in Fig. 4.

Fig. 8 shows the endovascular apparatus 10 according to a third aspect. In the embodiment shown in Fig. 8, the endovascular apparatus 10 includes a double-expandable attachment device 60 in the place of the first expandable attachment device 20. The double- expandable attachment device 60 comprises an upper expandable attachment device 62 and a lower expandable attachment device 64 which are separated by and attached to an o-ring seal 66. The upper attachment device 62 is angularly offset from the lower attachment device 64 so that the fixation components 36 of each are offset. The fixation components 36 may include prongs or barbs 67 to aid in securing the expandable attachment devices 62, 64 to the vessel wall. This design provides for secure attachment to the vessel wall with reduced leakage around the perimeter of the attachment device 60. The lower expandable attachment device 64 may be attached to the tubular sleeve 12. The upper expandable attachment device 62 maybe attached to the fourth expandable attachment device 28 by support columns 30.

Referring to Fig. 9, the endovascular apparatus 10 according to fourth aspect is shown. In this embodiment a plurality of "M springs" 68 are attached to the cranial end 14 of tubular sleeve 12 as graft expanders in order to hold the tubular sleeve 12 open. In this manner the M springs 68 may reduce leakage around the perimeter of the tubular sleeve 12. M springs 68 may also be used to hold the caudal ends 16, 18 of the tubular sleeve 12 open. In the embodiment shown in Fig. 9, the M springs 68 are not attached to the segments 52 of the telescoping arms 40 and are located on the exterior of the tubular sleeve 12. In another embodiment, the M springs 68 may be located on the interior of the tubular sleeve 12 or attached to the fixation components 36. Of course, in place of the "M springs" 68, springs in the shape of a "V may be used. Alternatively, in another embodiment depicted in Fig. 15, the M springs 68 may be replaced by telescoping arms 40 in an "M configuration."

Fig. 10 illustrates a typical abdominal aortic aneurysm 70 located in the infrarenal aorta 71. The infrarenal aorta 71 is that portion of the aorta 72 located below the renal arteries 74, 76. As shown in Fig. 10, abdominal aortic aneurysms typically occur below the renal arteries 74, 76 and above the common iliac arteries 78, 80. In some cases, the aneurysm includes the common iliac arteries 78, 80. The endovascular apparatus 10 may be used to treat or repair an abdominal aortic aneurysm 70, like the one shown in Fig. 10, by excluding the weakened aneurysmal aortic wall from pressurized and pulsatile flow. In addition, the endovascular apparatus 10 may be used to treat aneurysms or blockages located in other body lumens such as the thoracic aorta, iliac arteries, subclavian arteries, urinary tract, bile tract, intestinal tract, etc.

The endovascular apparatus 10 may be deployed at the site of an aneurysm percutaneously using a catheter 82 like the one shown in Fig. 11. The catheter 82 may have an IV port 84, a sheath 86 and an introducer 88 which can be withdrawn within the sheath 86. Using the catheter 82, the device can be introduced percutaneously through either of the femoral arteries. As shown in Fig. 17, using a "nested tube" design similar to the one utilized by the telescoping arms 40 of the attachment device 20, the catheter 82 may also be made to be telescoping.

During deployment the first expandable attachment device 20 may be positioned just below the renal arteries 74, 76 and seated with an expandable balloon or other actuator. The fourth expandable attachment device 28 may be positioned superior to the renal arteries 74, 76, the mesenteric artery, or the celiac artery and seated with an expandable balloon. After the first attachment device 20 is seated, the second expandable attachment device 22 may be positioned in a first iliac artery 78 and seated with an expandable balloon or other actuator. The third expandable attachment device 24 may be positioned such that it rests at a second iliac artery 80. To position and seat the third attachment device 24, access may be obtained percutaneously through the second iliac artery 80.

What is claimed is:

Claims

1. An attachment device that is expandable from a first state to a second state for securing an endovascular apparatus to an interior wall of a lumen, the device comprising:

a plurality of telescoping arms, the arms being operatively connected to one another so as to form a perimeter of variable length; and

a fixation component operatively coupled to the plurality of arms to anchor the attachment device to the wall of a lumen when the attachment device is expanded to the second state.

2. The attachment device of Claim 1, wherein the longitudinal axes of the arms are co- planar in the first state.

3. The attachment device of Claim 1, wherein the arms are connected to one another in an M configuration.

4. The attachment device of Claim 1 , wherein the ends of adjacent arms are operatively connected for pivotable movement.

5. The attachment device of Claim 1, wherein each telescoping arm comprises incrementally-sized segments that are slideably received within one another.

6. The attachment device of Claim 5, wherein the segments are tubular.

7. The attachment device of Claim 5, wherein each of the plurality of arms further comprises a one-way latch that allows the arm to extend but not to contract.

8. The attachment device of Claim 7, wherein the one-way latch comprises at least one groove associated with a first segment of a telescoping arm and at least one tooth associated with a second, adjacent segment of the telescoping arm, the at least one groove and at least one tooth being aligned for engagement with one another as the first segment slides relative to the second segment.

9. The attachment device of Claim 1, wherein the fixation component is located at the juncture of adjacent telescoping arms.

10. The attachment device of Claim 1, wherein the arms are made of stainless steel.

11. The attachment device of Claim 1 , wherein the arms are made of a nickel-titanium alloy.

12. The attachment device of Claim 1, wherein the attachment device when in the first state possesses a first profile that is sufficiently small to permit it to be percutaneously inserted via catheter into either of a patient's femoral arteries.

13. The attachment device of Claim 1, wherein at least one of the plurality of telescoping arms includes an aperture for releasing an adhesive contained within the at least one arm.

14. An attachment device that is expandable from a first state to a second state for securing an endovascular apparatus to an interior wall of a lumen, the device comprising:

an upper expandable device and a lower expandable device, each expandable device comprising

a fixation component operatively coupled to the plurality of arms to anchor the expandable device to the wall of a lumen when the attachment device is expanded to the second state;

wherein the upper expandable device is coupled to the lower expandable device such that the fixation component of the upper expandable device is angularly offset from the fixation component of the lower expandable device.

15. The attachment device of Claim 14, wherein the upper expandable device is coupled to the lower expandable device by an o-ring seal.

16. An endovascular apparatus comprising:

a tubular sleeve having a cranial end and a caudal end, the tubular sleeve suitable for forming a flow path for by-passing an aneurysm or vascular blockage; and first and second attachment devices attached to the cranial and caudal ends of the tubular sleeve, respectively, to hold the sleeve open and secure the sleeve to a wall of a lumen, the first and second attachment devices being expandable from a first state to a second state and each comprising

a fixation component operatively coupled to the plurality of arms to anchor the attachment device to a wall of a lumen when the attachment device is expanded to the second state.

17. The endovascular apparatus of Claim 16, further comprising a third attachment device coupled to the first attachment device by a plurality of support columns and positioned above the first attachment device such that the first attachment device is positioned between the second and third attachment devices, the third attachment device comprising

18. The endovascular apparatus of Claim 17, wherein the support columns are telescoping support columns of variable length.

19. The endovascular apparatus of Claim 18, wherein the support columns comprise a plurality of incrementally-sized segments that are slideably received within one another.

20. The endovascular apparatus of Claim 19, wherein at least one of the telescoping support columns includes an aperture for releasing an adhesive contained within the support column.

21. The endovascular apparatus of Claim 17, wherein the third attachment device is positioned above a patient's renal arteries and the first attachment device is positioned below the patient's renal arteries.

22. The endovascular apparatus of Claim 16, wherein the first and second attachment devices are coupled together by a plurality of support columns.

23. The endovascular apparatus of Claim 16, further comprising at least one spring for exerting a force on at least one of the first and second attachment devices to prevent said attachment device from collapsing from the second state to the first state.

24. The endovascular apparatus of Claim 16, further comprising at least one telescoping arm in an M configuration for exerting a force on at least one of the first and second attachment devices to prevent said attachment device from collapsing from the second state to the first state.

25. An endovascular apparatus comprising:

a tubular sleeve having a cranial end, a first caudal branch, and a second caudal branch; and

first, second, and third expandable attachment devices attached to the cranial end, the first caudal branch, and the second caudal branch of the tubular sleeve, respectively, to hold the sleeve open and secure the sleeve to a wall of a lumen, the first, second, and third attachment devices being expandable from a first state to a second state and each comprising

26. The endovascular apparatus of Claim 25, further comprising a fourth attachment device coupled to the first attachment device by a plurality of support columns and positioned above the first attachment device such that the first attachment device is positioned between the fourth attachment device on one hand and the second and third attachment devices on the other hand, the fourth attachment device comprising

a plurality of telescoping arms, the arms being operatively connected to one another so as to form a perimeter of variable length; and a fixation component operatively coupled to the plurality of arms to anchor the attachment device to a wall of a lumen when the attachment device is expanded to the second state.

27. The endovascular apparatus of Claim 25, further comprising a fourth attachment device attached to the cranial end of the tubular sleeve below the first attachment device but above a junction of the first caudal branch and the second caudal branch such that the fourth attachment device is positioned between the first attachment device on the one hand and the second and third attachment devices on the other hand, the fourth attachment device comprising

28. An attachment device that is expandable from a first state to a second state for securing an endovascular apparatus to an interior wall of a lumen, the device comprising:

at least one telescoping arm comprising a plurality of segments; and

a fixation component operatively coupled to the at least one telescoping arm to anchor the attachment device to the wall of a lumen.

29. The attachment device of Claim 28, further comprising a plurality of telescoping arms coupled together in an M configuration.

30. An endovascular apparatus comprising:

a tubular sleeve having a cranial end and a caudal end; and

first and second attachment devices attached to the cranial and caudal ends of the tubular sleeve, respectively, to hold the sleeve open and secure the sleeve to a wall of a lumen, the first and second attachment devices being expandable from a first state to a second state and each comprising at least one telescoping arm comprising a plurality of segments; and

31. An endovascular device for percutaneous deployment of an endovascular apparatus, the device comprising:

a telescoping sheath including a plurality of incrementally-sized segments that are slideably received within one another;

an introducer slideably received within the sheath; and

an inflatable balloon slideably received within the sheath.